Let me be clear: there is nothing in the Better Care Reconciliation Act (the term for the bill that is currently under discussion in the Senate) that can be considered an improvement over the existing healthcare laws under the Affordable Care Act. In fact, in many regards, the BCRA is a massive rollback of the progress made by the passage of the ACA in 2010. Having read the text of the bill (which is not difficult, considering it’s only 142 pages), it is unclear to me how anyone can honestly say that the bill offered by the Senate addresses the problems with the ACA that Republicans have bemoaned for the past 6-plus years.
In fact, it is so unpopular that Senate Majority Leader Mitch McConnell had to delay the planned vote on the BCRA this Friday, for fear that it wasn’t even popular enough among Republicans to pass the Senate.
I recognize that a lot of times, much of the debate over proposed legislation is intentionally sensationalized — both parties have a history of cherry-picking and magnifying the most undesirable elements of a bill while ignoring the positive aspects. But this is not one of those times. The contents of this bill are not subject to partisan interpretation. There is nothing, and I mean nothing, in the BCRA that is intended to protect uninsured and/or under-insured Americans.
Under the BCRA, Medicaid — which is available to any individual whose financial standing (that is, income up to 400% of poverty level) would otherwise preclude them from getting health insurance — would be cut starting in 2021. (As I go through some of the more heinous parts of this bill, you’ll notice that a lot of the more damaging ideas aren’t scheduled to take effect until after election years.)
Under the BCRA, insurance companies “would be required to accept all applicants regardless of health status.” Which sounds great, until you recall that the Affordable Care Act already had that same stipulation; meanwhile, under the BCRA, states would also be allowed to ask permission to reduce required coverage, which could potentially allow insurance companies to charge more for, at best, the same level of coverage they previously provided (and at worst, charge more for inferior coverage).
Under the ACA, mental health care is considered an essential health benefit, meaning it’s covered no matter who your insurer is. If your specific private insurer doesn’t cover mental health, Medicaid would still cover it. But under the BCRA, Medicaid would not be required to cover mental health care after — you guessed it — 2019.
And finally, under the ACA, there was no limit to the amount of coverage an individual could receive; under the BCRA, a lifetime limit would be allowed, which in essence means that if your insurance company has paid out $1 million over your lifetime (i.e., if you’re dealing with a chronic illness), they can stop your coverage with no questions asked.
There are plenty of terrible elements of this bill (and I really do suggest that you read the bill in its entirety). The primary argument from Republicans is that too much federal money is being spent on Medicaid as a result of the Affordable Care Act; not only that, they claim that the money is being wasted when it could be used more efficiently.
So how do they plan to improve the healthcare system? Well… they don’t.
If you want to argue the merits of a bill such as the BCRA from a fiscal standpoint, I’m all ears, though I would argue that the wealthiest nation in the world can afford the cost, and besides, affordable healthcare — not “access” to healthcare that is either so expensive as to be unattainable or offers so little that it provides no real value to the person receiving it — should be considered a basic human right at this point. But if you’re a fiscal conservative, I can maybe see your side of things.
But if you want to argue that this bill does anything to address 1) the problems with the Affordable Care Act; 2) the challenges of the health care system in general, or; 3) the very real fact that 28.5 million Americans still don’t have any health insurance, I can’t help you there. The authors of this bill want to change the healthcare system, but not for the better. In order for Republicans to actually address the problems that I readily concede do exist with the Affordable Care Act, they would have to spend more money; to do that, they would have to increase taxes on the wealthy.
Of course, that’s not what’s happening. By now, it’s as close to common knowledge as it gets that the whole purpose of revamping the health care laws is as cover to provide a massive tax cut to the wealthy. So while the Affordable Care Act levied additional taxes against the wealthy in order to offset the cost of the program, the BCRA plans to remove that requirement, cutting taxes for the wealthy — households making over $250,000 a year — and corporations by nearly $1 trillion over the next decade. The money has to come from somewhere for those tax cuts, and Republicans have decided that the best way to free up that money is by slashing the insurance benefits (and therefore the costs) of the roughly 23 million people who are most in need of these services: the poor, the disabled, the elderly.
(Also, to anybody who wants to offer the “trickle-down” economics take: That theory assumes that the wealthy will use whatever tax cuts they receive to altruistically help those less fortunate. The wealthy bitch enough as it is about having to pay taxes, so what in the world makes you believe that they’ll use that money to benefit the poor, especially if they’re no longer required to give it up?)
As I’ve mentioned before, American politics is no longer about elected officials working together for the overall good of their constituents. There is no goodwill, no faith in the other side, no spirit of cooperation. It is, for all intents and purposes, a deathmatch, the results of which can only be rendered in black or white: either you win or you lose. It doesn’t matter what your constituents want, as long as you keep the majority of them happy enough to continue voting for you. One party seizes power from the other and does whatever they want, then the other party regains power and does whatever they want.
They don’t engage in this legislative pissing match because it’s good for their constituents, but because there’s no better way to spite your opponent and energize your base than by forcing your opponent to watch helplessly as you unravel all their hard work. Even if that unraveling will solely benefit the ultra-wealthy who will never have to feel the effects of this proposed legislation while leaving tens of millions of poor and disabled Americans — citizens of the country you love oh, so much — with few options to get the care they need and even fewer ways to pay for it.
That’s how you end up with a bill as monstrously cruel as the BCRA. This bill steps on the backs of those most in need, all in service of providing additional unnecessary financial benefits to those who will barely notice the difference in their bank accounts. It is a clear sign that those who wrote it have no regard for the people for whom they claim to speak. It is an abomination, and it will cost lives.
And to those crowing about the potential demise of the ACA, I offer a word of warning: unless you’re making over $250,000 a year, I hope you don’t lose your job, become terminally ill, or plan on aging. You’ll be singing a different tune when it’s your turn in the barrel.